News Scan for Mar 09, 2020

New Saudi MERS cases
;
Bias in flu case definitions

Two new Saudi MERS cases reported

Over the weekend Saudi Arabia's Ministry of Health (MOH) reported 2 new MERS-CoV cases, 1 each in Mecca and Riyadh, bringing the country's March tally to 6 infections, after the ministry reported 18 cases in February and 15 in January.

The MERS-CoV (Middle East respiratory syndrome coronavirus) case in Mecca involves a 64-year-old man. The MOH listed the case as primary, meaning he is unlikely to have contracted the virus from another person. The patient is not a healthcare worker, and his contact with camels is unknown.

Yesterday the MOH reported that a 35-year-old man from Riyadh was also diagnosed as having MERS. His case is also listed as primary, but he did have contact with camels, a known risk factor for contracting the disease.

As of Jan 31, the World Health Organization said that it had received reports of 2,519 laboratory-confirmed MERS infections, including 866 associated deaths. The vast majority of these cases occurred in Saudi Arabia.
Mar 7 MOH report
Mar 8 MOH report

 

Study: Flu case definitions often invalid in seniors

Flu surveillance case definitions miss many hospitalized patients 65 years and older who have laboratory-confirmed infection—especially those who are frail, according to a prospective cohort study in today's Infection Control & Hospital Epidemiology.

Researchers from the Canadian Immunization Research Network and Serious Outcomes Surveillance (SOS) Network determined that standard influenza-like illness (ILI) and severe acute respiratory illness (SARI) case definitions are biased toward detecting infection in people younger than 65 and thus do not characterize the true burden of the flu.

The validity of flu case definitions is important because older people, who are particularly susceptible to the flu and its complications, often have atypical signs and symptoms of infection.

The researchers used pooled data from the 2011-12, 2012-13, and 2013-14 flu seasons and measured frailty using a validated frailty index. Of 11,379 adult inpatients (7,254 older than 65), 4,942 (2,948 older than 65) had laboratory-confirmed flu. The patients' median age was 72 years (interquartile range [IQR], 58 to 82), and 52.6% were women.

The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6% to 52.6%) for adults younger than 65 versus 44.6% (95% CI, 43.6% to 45.8%) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7% to 65.6%) of the younger adults versus 57.1% (95% CI, 55.9% to 58.2%) of older patients with laboratory-confirmed flu. Frail or prefrail patients were less likely than their peers to fit ILI and SARI case definitions.

"Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza," the authors wrote.

The SOS Network conducts active surveillance for flu in hospitalized adults.
Mar 9 Infect Control Hosp Epidemiol abstract

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